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From page 241... ... 7 Determining Optimal Weight Gain INTRODUCTION In this chapter, the approach used by the committee for arriving at its recommendations for revision of the current guidelines for weight gain during pregnancy is discussed. First, a brief discussion of the principles used by the committee to develop a strategy for making its recommendations is presented. Read the entire page →
From page 242... ... 242 WEIGHT GAIN DURING PREGNANCY outcomes and their frequency in the population. To develop estimates of risk and frequency, the committee used data from the published literature and from additional, commissioned analyses (see below) Read the entire page →
From page 243... ... DETERMINING OPTIMAL WEIGHT GAIN 243 PREVIOUS APPROACHES FOR DEVELOPING WEIGHT GAIN RECOMMENDATIONS Many approaches have been and are currently being used for making recommendations for how much weight women should gain during pregnancy. At one extreme is the advice from the National Center for Clinical Excellence in the United Kingdom that women should not be weighed at all during pregnancy, "as it may produce unnecessary anxiety with no added benefit" with the exception being "pregnant women in whom nutrition is of concern" (National Collaborating Centre for Women's and Children's Health, 2008) Read the entire page →
From page 244... ... 244 WEIGHT GAIN DURING PREGNANCY Baseline 150 150 140 140 130 130 Weight/Height 120 120 110 110 100 100 90 90 80 80 10 15 20 25 30 35 40 Gestational Age (Weeks) FIGURE 7-1 Graphic showing weight increase for pregnant women. Read the entire page →
From page 245... ... DETERMINING OPTIMAL WEIGHT GAIN 245 analysis be undertaken "in which probabilities and utilities (values) are assigned to each potential outcome" to assist in balancing the risks and benefits of any recommendation. Read the entire page →
From page 246... ... 246 WEIGHT GAIN DURING PREGNANCY for Cedergren's analysis (2007) , none of these investigators considered the frequency or severity of these events, and the outcomes of pregnancy were restricted to those at delivery. Read the entire page →
From page 247... ... DETERMINING OPTIMAL WEIGHT GAIN 247 variety of maternal and neonatal outcomes associated with prepregnant BMI and GWG and their interaction. For those outcomes with a strong independent association with GWG and little possibility of reverse causality (unscheduled primary cesarean delivery, SGA, LGA, and postpartum weight retention ≥ 5 kg) Read the entire page →
From page 248... ... 248 WEIGHT GAIN DURING PREGNANCY TABLE 7-1 Summary of Research Published Since the IOM (1990) Report in Which Recommendations for Optimal Weight Gain During Pregnancy Are Developed Proposed Optimal Weight Gain During Pregnancy (kg) Read the entire page →
From page 249... ... DETERMINING OPTIMAL WEIGHT GAIN 249 STRATEGIC APPROACH USED BY THE COMMITTEE IN DEVELOPING ITS RECOMMENDATIONS To address these conflicts and gaps within the available literature, the committee commissioned several additional analyses that informed its decision making (Table 7-2) (see Appendix G) Read the entire page →
From page 250... ... 250 WEIGHT GAIN DURING PREGNANCY her published analyses from the Danish National Birth Cohort (Nohr et al., 2008) Read the entire page →
From page 251... ... DETERMINING OPTIMAL WEIGHT GAIN 251 of Health (NHLBI, 1998) Read the entire page →
From page 252... ... 252 WEIGHT GAIN DURING PREGNANCY < 18 years old, the WHO BMI cutoff points for overweight and obesity often do not correspond to the 85th and 95th percentiles, respectively, of the Centers for Disease Control and Prevention (CDC) pediatric growth charts that used to assess growth in these girls (available online at http://www.cdc. Read the entire page →
From page 253... ... DETERMINING OPTIMAL WEIGHT GAIN 253 Racial/Ethnic Group The descriptive observational data cited in Chapter 4 suggested that inadequate GWG was more common in some racial/ethnic groups. However, only Dr. Read the entire page →
From page 254... ... 254 WEIGHT GAIN DURING PREGNANCY women, smokers would have to gain at least 16-19 kg instead of 5-9 kg to have a 10 percent risk of having an SGA infant. If they were to gain in this higher range, their risk of retaining ≥ 5 kg at 6 months postpartum would be over 20 percent instead of being about 5 percent. Read the entire page →
From page 255... ... DETERMINING OPTIMAL WEIGHT GAIN 255 hood obesity) Read the entire page →
From page 256... ... 256 WEIGHT GAIN DURING PREGNANCY 1. Before conception, use consistent and reliable procedures to mea sure and record in the medical record the woman's weight and height without shoes. Read the entire page →
From page 257... ... DETERMINING OPTIMAL WEIGHT GAIN 257 gained < 5 kg. It is possible, based on the data collected in these investigations and compared to higher gains, that weight gains < 5 kg may be associated with a more favorable trade-off among outcomes. Read the entire page →
From page 258... ... 258 WEIGHT GAIN DURING PREGNANCY women, with increased risk of LGA and its consequences. As additional experimental data are generated to confirm or refute a causal interpretation of the evidence linking GWG and fetal growth, this reasoning may need to be revised. Read the entire page →
From page 259... ... DETERMINING OPTIMAL WEIGHT GAIN 259 veloped from published and commissioned research data needed to support a more complete and persuasive analysis were unavailable. In particular, more information is needed on associations between GWG and longer term maternal outcomes, such as postpartum weight retention and later reproductive function and health, and child health outcomes such as fetal growth restriction, child neurocognitive outcomes, and obesity. Read the entire page →
From page 260... ... 260 WEIGHT GAIN DURING PREGNANCY outcomes of mothers and children that occur after the neonatal period. Read the entire page →
From page 261... ... DETERMINING OPTIMAL WEIGHT GAIN 261 REFERENCES Abrams B., S Carmichael and S Read the entire page →
From page 262... ... 262 WEIGHT GAIN DURING PREGNANCY Straube S., M Voigt, V Read the entire page →

From page 241...

... 7 Determining Optimal Weight Gain INTRODUCTION In this chapter, the approach used by the committee for arriving at its recommendations for revision of the current guidelines for weight gain during pregnancy is discussed. First, a brief discussion of the principles used by the committee to develop a strategy for making its recommendations is presented.